Quality Management Nurse Consultant (OhioRISE)

Support the OhioRISE Program, a managed care initiative providing coordinated behavioral health services for children with complex needs. Responsibilities include Potential Quality of Care (PQOC) monitoring, critical incident reporting, and collaboration with plan HEDIS teams on OhioRISE-specific measure reporting, education, and monitoring. Develop quality strategy and framework for a medically complex population, and monitor/track OhioRISE Program performance measures. Collect and monitor data related to Trauma Informed Care, Adverse Childhood Events, and other required training outcomes. Participate in OhioRISE-specific performance improvement projects and assist with NCQA deliverables, including reviewing and evaluating clinical information and documentation.

Develop, update, and maintain Incident Management System (IMS) training to ensure staff and stakeholders understand incident definitions, reporting expectations, timelines, roles, documentation standards, and prevention planning. Translate regulatory and internal process requirements into accessible learning materials (facilitator guides, job aids, scenario-based content). Enter data into the IMS and partner with Psychiatric Residential Treatment Facilities, Care Management Entities, and the Ohio Department of Medicaid on critical incident inquiries.

Remote position with up to 10% travel. Requires active unrestricted RN license, 3+ years clinical experience, and familiarity with Ohio's system of care. NCQA, HEDIS, behavioral health, and managed care experience preferred. Salary $60,522–$129,615 plus bonus eligibility.